The present invention relates in general to medical dressings, and in particular, to a new and useful apparatus and technique for covering abdominal wounds. The apparatus does not require the aid of adhesives or tapes which often cause trauma, significant problems, and even pain to patients. It also accommodates abdominal devices such as drains or ostomies and is totally adjustable. The invention is also easily laundered and can be re-used. This is an important factor, since many surgical patients have wounds that require several weeks or months for healing.
The practice of surgery, particularly the field of abdominal surgery, requires incisions through the skin and abdominal wall. The resulting surgical wounds are covered with bandages or dressings to minimize infection and aid in the healing process. Many times intra-abdominal processes exist that are, by their nature, contaminated procedures. These contaminated procedures routinely require the skin and subcutaneous tissues to be left open and subsequent wound care provided. It is frequently necessary to leave drains within the abdominal cavity, exiting though the skin. When colonic or bowel surgery is involved, ostomies may be created. An ostomy is a portion of the opened intestinal tract that is connected to the skin and serves as an exit site for intestinal contents. These intestinal contents, i.e. feces, are collected in plastic bags placed over the ostomies on the abdominal wall. These abdominal procedures and operations are common and routine in modern medicine and are performed on a daily basis.
Currently, abdominal wounds are dressed with sterile gauze or bandages placed over or within the wounds. These dressings are secured in place, in one of two ways. The most commonly used method is with adhesive tapes. The second, less common method is the use of Montgomery straps. Montgomery straps are adhesive dressings that are applied adjacent both sides of the wound. These adhesive portions are connected to non-adhesive panels which have holes running parallel to the wound. Lacings are placed through these holes to secure the dressings to the abdominal wound.
Present understanding and historical information confirm that adhesive dressings are less than ideal. Trauma is incurred to the skin when removing the adhesive tape or adhesive dressing from the abdominal wall. This results in blisters, irritation, and new wounds. Many patients also react to adhesive tapes, in the form of contact dermatitis, incurring even further trauma. These disadvantages of adhesive dressings and adhesive tapes are well recognized in modern surgery as well as in historical reports.
Several attempts have been made to overcome the problems encountered with adhesive tape. However, none of these attempts have proved beneficial and are not used in today's surgical therapies.
One device disclosed in U.S. Pat. No. 2,531,757 to Whinery in 1947 attempted to provide a surgical dressing without adhesive tapes. This dressing was a bandage providing a circumferential binder to the wound using leg straps to prevent slippage of the bandage. The device was constructed of ordinary cloth with a small amount of elastic over the lateral aspects. It wrapped completely around the abdomen and was secured in place with interdigitating straps that were pinned laterally. This dressing covered the anterior portion of the abdomen, almost in its entirety. The Whinery device is not used in modern surgery, for multiple reasons. First the circumferential dressings lead to respiratory compromise in the postoperative abdominal surgery patient. Secondly, it required leggings that made it difficult for nursing tasks to be performed. Placement of the device, as well as caring for the bodily functions of the patient, i.e., defecation and urination, were very difficult. Furthermore, this dressing does not accommodate intra-abdominal drains or ostomies which exit from the anterior abdominal wall.
A similar attempt is disclosed in U.S. Pat. No. 3,486,501 to Erickson, et al., issued in 1969. This device was called an abdominal scultetus and in essence was designed similar to underwear or mens' briefs. It was somewhat adjustable and extended from the genitalia region up to the abdomen. This device had the same drawbacks as the Whinery device in that it was circumferential and rendered respiratory compromise, it provided no openings for ostomies, drains, or other such devices, and it covered the anal and genitalia region. The Erickson, et al. dressing made it even more difficult for those patients who were incontinent of urine or stool after their operative procedures. This drawback, coupled with the difficulty in applying the device greatly increased the need for nursing care. The device also failed to win any clinical acceptance and offered very little to the post-operative abdominal surgery patient.
In 1966, Bailey developed a surgical bandage which was fashioned somewhat after the Montgomery straps. See U.S. Pat. No. 3,417,749. This too, was a completely encircling bandage that again contributed to respiratory compromise. It did not have a portion that extended through the genitalia nor the gluteal region, however it was associated with the problem of slippage and did not stay firmly on the wound.
Surgical binders have been developed, which are circumferential and encase abdominal wounds. See U.S. Pat. No. 3,442,270 to Steinman. The Steinman binder was created to render support to the weakened body areas. However, this theory required that support be given for the abdominal musculature, and this theory is not routinely upheld. In most cases, support is not needed and the circumferential stress causes respiratory compromise and postoperative pulmonary problems. Therefore, the surgical binder, while giving support to the back and lower abdominal wall, serves no great purpose in securing abdominal dressings. Likewise, the circumferential binder has no accommodation for any abdominal drains, ostomies or devices attached to the abdominal wall.
In summary, all attempts have been unsatisfactory in providing a suitable device to hold abdominal dressings intact. What is needed is a device that will: secure abdominal dressings to the wound without the use of adhesives; provide adequate latitude for intra-abdominal drains and ostomies; be made of affordable and usable material; be simple to apply and use; and not contribute or cause respiratory compromise by complete circumferential compression.